Hypofractionated Radiation Therapy for Breast Cancer: A Unit Review in Alignment with International Guidelines

Area of Science:

• Radiation Oncology
• Breast Cancer Treatment
• Health Systems Research

Background:

• International guidelines recommend hypofractionated whole-breast irradiation (HF-WBI) for early breast cancer due to its efficacy and shorter treatment duration.
• Real-world adoption of HF-WBI is crucial in resource-constrained settings like South Africa, where treatment access and efficiency are paramount.

Purpose of the Study:

• To evaluate the adoption rate and adherence to guideline-based practice of HF-WBI at a South African center.
• To assess the feasibility of HF-WBI implementation, including boost utilization and age inclusivity.

Main Methods:

• Retrospective review of breast cancer patients receiving radiotherapy between 2018 and 2024.
• Stratification of patients based on conventional WBI (CF-WBI), hypofractionation (HF-WBI), and ultra-hypofractionation.
• Analysis of annual HF-WBI adoption, patient age distribution, and boost delivery among those undergoing breast-conserving therapy (BCT).

Main Results:

• A significant increase in HF-WBI adoption was observed, rising from 12.3% in 2018 to 82.4% by 2024.
• Ultra-hypofractionation (≈26 Gy/5 fractions) emerged from 2022 onwards.
• HF-WBI was utilized across all age groups (<50 and ≥50 years), with consistent boost delivery, indicating flexible protocol adherence.

Conclusions:

• The study demonstrates a successful transition to HF-WBI as the predominant breast radiotherapy regimen in the evaluated South African center.
• Real-world implementation is feasible, aligning with international standards while enhancing patient convenience and departmental efficiency.
• Wider adoption of HF-WBI and selective ultra-hypofractionation can improve access and sustainability in resource-limited healthcare systems.